Lung Cancer

Here's the pdf for this presentation: Inherited T790M EGFR Mutation

How should we conduct trials of targeted therapies in lung cancer if large randomized trials require hundreds to thousands of patients, cost millions of dollars and years to conduct, but are extremely likely to have negative results and will require a more refined population with a prospectively defined target? We'll tackle that question in our upcoming #LCSM chat on Thursday, March 27th at 8 PM ET, 5 PM PT. Topics will include:

After a full morning, this conference has a nice feature during the lunch break of having the faculty all sit at separate tables so that attendees can ask questions of them. It’s nice to break through the silos that typically have the faculty sit and talk together, which may create a barrier to having these important conversations between the meeting attendees and the few on the faculty.

Over the last couple of years, I’ve attended and spoken at a lung cancer conference that I find to be particularly gratifying. Each fall, the Annual Personalized Therapies in Lung Cancer conference is held at a location in southern California. I wanted to provide a summary of what was covered at the last one, back in November, since it covered a broad range of the topics I think are most interesting here, using an interactive, case-based format integrated into the presentations.  

Here is a brief and basic summary of the concept of why we're concerned not only about the cancer we can see but the potential cancer we can't.

Since the introduction of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) for patients with lung cancer, we have seen a subset of patients do remarkably well, with dramatic and long lasting responses. Unfortunately, within a few months of those impressive responses, we learned that people invariably develop acquired resistance to these agents.

One of the challenges of cancer care is that we guide our treatments by what clinical trial evidence tells us is best for particular patient populations. However, trials exclude patients who have significant medical issues other than cancer.

There is a principle in management of lung cancer that some patients who have a very limited degree of metastatic disease or progression after a good response may do unusually well with local treatment, such as radiation or surgery, for the isolated area(s) of disease that are metastatic or growing.

This past week, I saw a new patient who had just moved from another part of the country and needed long-term management of her high risk lung cancer.  A never-smoking Asian woman, she was found to have a stage IIIA lung cancer with "N2" mediastinal lymph nodes involving cancer in her mid-chest.